Chest guidelines thrombophlebitis

Lemierre's syndrome is a condition characterized by septicemia, with bacteremia, thrombophlebitis of the internal jugular vein (IJV), and septic embolization to distant organs following a recent upper respiratory infection (URI). Fusobacterium necrophorum, an anaerobic Gram-negative rod, has been mostly implicated as the causative organism of this condition that tends to affect healthy teenagers and young adults. While once regarded as a disease of old, it has seen a resurgence in recent times, possibly due to antibiotic stewardship and current trends of reduced antibiotic use for URIs...

OBJECTIVE: To determine the value of computed tomography (CT) angiography of the chest as a diagnostic test to exclude pulmonary embolism and to assess compliance with diagnostic protocols for thromboembolic disease. PATIENTS AND METHODS: We retrospectively studied patients who underwent CT angiography of the chest because of suspected pulmonary embolism in 2004. All the patients were followed for 3 months. The percentage of patients diagnosed with a thromboembolic event based on an objective test during the follow-up period was determined...

The introduction of low-molecular-weight heparins (LMWHs) has contributed to major improvements in the management of venous thromboembolism (VTE). The LMWHs have been shown to be as effective as, and safer than, unfractionated heparin (UFH) in the prevention and treatment of VTE, and their use is included as a grade 1A recommendation in the Sixth American College of Chest Physicians Guidelines. Important practical disadvantages of treatment with UFH are the need for extended hospital stays and frequent monitoring of coagulation levels...

Diagnosis of clinically suspected deep venous thrombosis is based on a clinical score, serial compression ultrasonography and D-dimer assay. For the diagnosis of pulmonary embolism perfusion scintigraphy, ventilation scintigraphy, echography of the leg veins and pulmonary angiography in that order lead to the lowest mortality, morbidity and costs. Diagnostics with spiral CT followed by pulmonary angiography leads to equal mortality and fewer angiography procedures. Decision rules based on anamnesis, physical examination, blood gas analysis and chest radiograph have proved to be insufficiently reliable...

Since the NIH Consensus Conference in 1986, the developments in the field of prevention and treatment of venous thromboembolism were mainly characterized by a more specific and extended use of new prophylactic agents such as low-molecular-weight heparins as well as the perception that out-patients may be at risk for thromboembolic complications, too. Therefore, in 1991 and 1995, consensus conferences were held in Europe and North America in order to analyze the risk constellation of various patient populations and to give recommendations for primary prophylaxis and treatment of thromboembolic complications...

Guidelines for prophylaxis of deep vein thrombosis secondary to orthopedic surgery have been developed. In selecting a specific drug for formulary inclusion, it is ideal for an individual institution to determine the cost of therapy, as well as the frequency of adverse events and the cost of treating them for each agent undergoing consideration. Cost-effectiveness analysis using incremental cost-effectiveness ratios and sensitivity analyses are useful for determining which drug may be most cost effective.

The incidence of deep vein thrombosis (DVT) after total knee replacement surgery is reported to occur in 84% of all unprotected patients and may be as high as 68% in patients who receive DVT prophylaxis. Moreover, controversy exists as to which pharmacologic or mechanical agent is most effective. Although the scientific literature provides some answers, many issues of DVT prophylaxis are not completely addressed, especially with regard to the duration of prophylaxis. The most recent report from the American College of Chest Physicians Consensus Conference on Antithrombotic Therapy reconfirms the recommendations offered from previous consensus groups on the importance of establishing and applying a universal protocol for the prevention of DVT in orthopedic surgery...